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call_to_action_demand_a_better_federal_balance_billing_solutionCall to Action: Demand a Better Federal Balance Billing SolutionLatest_NewsShared_Content/News/Membership_Memo/20191211/call_to_action_demand_a_better_federal_balance_billing_solution<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Concepts/Megaphone-Evergreen-645x425px.jpg" class="pull-right" alt="megaphone graphic" /> </div> <h5> December 11, 2019 </h5> <h2> Call to Action: Demand a Better Federal Balance Billing Solution </h2> <p> </p> <p> <a href="https://www.modernhealthcare.com/politics-policy/surprise-billing-tweaks-fail-win-provider-support">News broke this week</a> of a potential compromise in Congress on federal legislation banning balance billing. The proposal, while protecting patients from surprise bills, would set initial reimbursement from insurance carriers at the median in-network rate paid for the service in the geographic area. A similar proposal in here in Washington was opposed by the WSMA due to concerns about the power that would shift to carriers in contract negotiations. The legislation under consideration also sets a $750 threshold for independent dispute resolution and does not allow for claims bundling - therefore eliminating recourse for any payment from carriers that's below $750. </p> <p> Details of the legislation are still being negotiated, and as of the time of this writing, Sen. Patty Murray (the lead Democrat on the Senate committee where the bill is being considered) has not yet lent her support. If this issue is important to you and your practice, contact your congressional representatives today. The primary concerns of the physician community in the draft compromise bill are the rate-setting provision and the threshold for independent dispute resolution. </p> <p> Contact Sen. Murray and other members of your congressional delegation using the <a href="https://www.senate.gov/general/contact_information/senators_cfm.cfm">Senate</a> and <a href="https://www.house.gov/representatives">House</a> websites or the <a href="https://physiciansgrassrootsnetwork.org/be-heard?vvsrc=%252fcampaigns%252f67405%252frespond%253futm_source%253dAction%252520Alert%2526utm_medium%253dPGN%2526utm_campaign%253dSurprise%252520Billing%2526utm_content%253dSurprise%252520Billing">AMA Grassroots Action Center</a>. When sending a message, be sure to reference Washington's balance billing legislation, <a href="https://app.leg.wa.gov/billsummary?BillNumber=1065&Year=2019&Initiative=false">House Bill 1065</a>, as a model. Learn more about that bill <a href="https://wsma.org/Shared_Content/News/Weekly_Rounds/2019/weekly_rounds_apr_15_2019_taking_action_makes_a_difference">here</a>. </p> </div>12/11/2019 12:00:00 AM1/1/0001 12:00:00 AM
practice_impact_new_laws_taking_effect_jan_1Practice Impact: New Laws Taking Effect Jan. 1Latest_NewsShared_Content/News/Membership_Memo/20191211/practice_impact_new_laws_taking_effect_jan_1<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Concepts/Stock.image_2017.doctor.with.toddler_645x425px.jpg" class="pull-right" alt="Doctor with toddler" /> </div> <h5> December 11, 2019 </h5> <h2> Practice Impact: New Laws Taking Effect Jan. 1 </h2> <p> WSMA advocacy, with your support, makes a tangible difference for physicians, patients, and the practice of medicine in our state. The following is a look at legislation enacted in 2019 that goes into effect Jan. 1, and that may impact your practice or organization. </p> <p> More information on these new laws is provided where indicated. Contact the WSMA's new policy department at <a href="mailto:policy@wsma.org">policy@wsma.org</a> if you have questions. <em>HB = House Bill; SB = Senate Bill</em> </p> <p> <strong>Balance billing, HB 1065</strong> </p> <p> Bans balance billing in our state, requires health insurers to reimburse out-of-network physicians at a commercially reasonable rate, and creates an independent dispute resolution process. <a href="[@]Shared_Content/News/Membership_Memo/20191211/washingtons_balance_billing_ban_what_you_need_to_know.aspx">Here's what you need to know about this new law prior to implementation</a>. </p> <p> <strong>B&O tax increase, HB 2158</strong> </p> <p> Imposes a 20% surcharge on the business and occupation (B&O) tax paid by independent (i.e. non-hospital affiliated) physician practices, among other service businesses. The WSMA strongly opposed this targeted tax increase and will advocate for its repeal during the 2020 legislative session. Learn more about the issue on <a href="[@]WSMA/Advocacy/Legislative___Regulatory/No_to_B_and_O/WSMA/Advocacy/Legislative_Regulatory/No_to_B_and_O/no_to_b_and_o_.aspx?hkey=d5807781-a824-4b2c-a8f4-70ed597ddfa8">the WSMA website</a>. For latest developments, see <a href="[@]Shared_Content/News/Membership_Memo/20191211/sen_oban_announces_bill_to_repeal_b_and_o_tax_increase_on_health_care.aspx">this article in today's Membership Memo</a> . </p> <p> <strong>Non-competition clauses, HB 1450</strong> </p> <p> Limits the circumstances under which non-compete clauses may be used. Non-compete clauses will only be enforceable if: an employee earns more than $100,000 a year; an independent contractor earns $250,000 a year from the employer proposing a non-compete; the employer discloses terms of the non-compete at or prior to making an employment offer; the employer compensates employees who are laid off but still subject to non-compete agreements; and the non-compete agreement covers a period no longer than 18 months. </p> <p> <strong>Public option health plan (aka Cascade Care), SB 5526</strong> </p> <p> While effective this Jan. 1, the plans being developed by the state under SB 5526 won't be available until November 2020 for coverage beginning in 2021. <a href="[@]Shared_Content/News/Membership_Memo/20191211/preparing_for_cascade_care_free_webinar_for_physicians.aspx">Learn more about these plans and their cost-control mechanisms</a> (including statutory limits on reimbursement, which the WSMA opposes). </p> <p> <strong>Reproductive health care, SB 5602</strong> </p> <p> Prohibits discrimination based on an individual's gender identity or expression for reproductive health services purchased or contracted for by the Washington State Health Care Authority, including the use of automatic denials of coverage by managed care organizations. Effective Jan. 1, 2021, health plans and student health plans must provide coverage for certain reproductive treatments and services. Insurers must bill and collect payment with a single invoice that includes all covered benefits and services, and segregation plans must include a certification that the billing and payment processes meet the Office of the Insurance Commissioner's requirements. </p> <p> <strong>Substance and opioid use disorder, HB 5380</strong> </p> <p> While containing important provisions to improve the treatment of pain and increase access to medication-assisted treatment and naloxone, HB 5380 contains several notable provisions impacting medical practice: </p> <ul> <li> <p> Requires insurance companies to cover, without prior authorization, at least one FDA-approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists. </p> </li> <li> <p> Requires groups with 10 or more prescribers to integrate their certified electronic health record with the state's prescription monitoring program by 2021 and requires prescriptions for controlled substances to be communicated electronically beginning in 2021. The WSMA was able to obtain exemption processes for both mandates that consider economic hardship, technological limitations, or other exceptional circumstances. The WSMA will report to members when the Department of Health drafts rules outlining the exemption process. </p> </li> </ul> <p> More information will be forthcoming from WSMA publications on these provisions. </p> <p> <strong>Workplace violence prevention, HB 1931</strong> </p> <p> Hospitals, ambulatory surgical centers, and other facilities such as home care agencies and psychiatric facilities must develop and implement a violence prevention plan every three years that outlines strategies focused on security considerations and risk of violence factors. A review of workplace violence incidents and issues must be conducted annually. Violence prevention training must be provided to employees, volunteers, and contracted security personnel by July 1, 2020. Records of violent acts must be kept for at least five years after the act reported. </p> </div>12/11/2019 12:00:00 AM1/1/0001 12:00:00 AM
sen_oban_announces_bill_to_repeal_b_and_o_tax_increase_on_health_careSen. O'Ban Announces Bill to Repeal B&O Tax Increase on Health CareLatest_NewsShared_Content/News/Membership_Memo/20191211/sen_oban_announces_bill_to_repeal_b_and_o_tax_increase_on_health_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Advocacy/NoToBO-Graphic-645x425px.jpg" class="pull-right" alt="No to B&O logo" /> </div> <h5> December 11, 2019 </h5> <h2>Sen. O'Ban Announces Bill to Repeal B&O Tax Increase on Health Care</h2> <p> Repealing the B&O tax surcharge on independent physician practices is a key priority for the WSMA as we look toward the 2020 state legislative session. To that end, we're pleased to report that Sen. Steve O'Ban (R-Pierce County) has announced a bill that he is sponsoring for the legislative session that would <a href="http://steveoban.src.wastateleg.org/oban-fights-repeal-business-tax-increase-health-care-providers/">repeal the tax surcharge</a>. The WSMA appreciates the support Sen. O'Ban has provided on this issue, which has included an excellent <a href="http://steveoban.src.wastateleg.org/watch-video-series-bo-tax-increase-will-affect-family-budget-health-care/">video interview series with WSMA members</a> on the impact of the tax increase on their patients and businesses. However, support for repeal will need to come from all corners of the Legislature; if you haven't yet done so, contact your senator and representatives this week and urge them to prioritize patient access to care and physician practice viability by exempting health care from this misguided tax increase when they return to work in 2020. <a href="https://takeaction.wsma.org/no-bo-tax-increase-on-health-care/">Send a message today</a>. #NoToBandO </p> </div>12/11/2019 12:00:00 AM1/1/0001 12:00:00 AM
washingtons_balance_billing_ban_what_you_need_to_knowWashington's Balance Billing Ban - What You Need to KnowLatest_NewsShared_Content/News/Membership_Memo/20191211/washingtons_balance_billing_ban_what_you_need_to_know<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/Concepts/invoice_645x425.jpg" class="pull-right" alt="invoice" /> </div> <h5> December 11, 2019 </h5> <h2> Washington's Balance Billing Ban - What You Need to Know </h2> <p> After years of negotiations between the WSMA, stakeholders, and lawmakers, legislation banning balance billing in our state was passed by the Legislature earlier this year. Effective Jan. 1, the Balance Billing Protection Act (BBPA) will prohibit balance billing for emergency services and for certain procedures performed by out-of-network physicians working in in-network facilities. BBPA will apply to fully insured health plans in Washington, as well as self-insured health plans that opt to comply with the law. A webinar overview of BBPA designed for physicians is now available on demand, and two major steps toward implementation - rulemaking and defining a dataset to inform arbitration - have been finalized. </p> <p> <strong>OIC webinar on BBPA for physicians and hospitals</strong> </p> <p> The OIC recently presented a webinar on BBPA's implementation for members of the WSMA and the Washington State Hospital Association. The webinar has now been archived and <a href="https://vimeo.com/375038359">is available for viewing on demand</a>. The hour-long session covers BBPA's out-of-network provider payment and dispute resolution process, transparency provisions, enforcement, self-funded group health plan participation, and more. A Q&A with physicians in attendance is featured toward the close of the session. </p> <p> <strong>BBPA rulemaking finalized</strong> </p> <p> OIC has adopted rulemaking required by the BBPA. The WSMA provided comment at multiple junctures on this rule, which generally implements the balance billing legislation. Most of <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20191023/balance_billing_law_implementation_and_webinar">our concerns</a> were addressed through the rulemaking process. One exception is that we (and the hospital association) had requested a mechanism be stipulated for circumstances where an ERISA plan opts in to the law but does not comply; the OIC felt such a policy would jeopardize federal preemption. The final rule can be reviewed <a href="https://www.insurance.wa.gov/media/8671">here</a>; a summary of comments received from the WSMA and other stakeholders and responses from the OIC can be reviewed <a href="https://www.insurance.wa.gov/sites/default/files/2019-11/r-2019-04-ces.pdf" target="_blank">here</a>. </p> <p> <strong>Dataset for arbitration</strong> </p> <p> The OIC has published the dataset, made up of commercial, fee-for-service claims data from the state's all-payer claims database, that will be used as a reference for arbitration during the balance billing dispute resolution process. The goal of the dataset is to set a reference point for billed charges and contracted amounts for services by region. As a participant of the work group in charge of developing the dataset, the WSMA continues to express concerns that some of the amounts reflected by the data are too low. While the dataset has now been published, the work group is ongoing, and we are currently reaching out to specialty groups for their input on the data. The dataset and information on the arbitration process can be found <a href="https://www.insurance.wa.gov/arbitration-and-using-balance-billing-protection-act-data-set?utm_content=&utm_medium=email&utm_name=&utm_source=govdelivery&utm_term=">on the OIC website</a>. </p> <p> The WSMA is preparing a comprehensive summary of the BBPA for members, which will be available shortly. For questions, contact Sean Graham, WSMA's government affairs director, at <a href="mailto:sean@wsma.org">sean@wsma.org</a>. </p> </div>12/11/2019 12:00:00 AM1/1/0001 12:00:00 AM
understanding_cascade_care_free_webinar_for_physiciansUnderstanding Cascade Care: Free Webinar for PhysiciansLatest_NewsShared_Content/News/Latest_News/2019/December/understanding_cascade_care_free_webinar_for_physicians<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/Logos/Washington-State-Evergreen.jpg" class="pull-right" /></div> <h5>December 6, 2019</h5> <h2>Understanding Cascade Care: Free Webinar for Physicians </h2> <p> Senate Bill 5226, passed by the Legislature in 2019, created a new health insurance "public option" called Cascade Care to be offered through the state's health benefit exchange to the Washington individual market for coverage effective Jan. 1, 2021. </p> <p> The Washington State Health Care Authority, Washington Health Benefit Exchange, and the Office of Insurance Commissioner invite you to learn more about the new public option plans in development and how they may impact your practice. </p> <p> A free webinar targeted specifically at physicians, health care facilities, and other health care providers is scheduled for Monday, Dec. 16, from 1–3 p.m., and will provide an overview of Cascade Care public option plans and value requirements, as well as timelines for public comment and procurement process for carriers. HCA, HBE, and OIC leadership, together with actuary consultants working on the cost-control requirements, will be available to answer your questions regarding the new plans and potential impacts on physician and provider businesses. (One of the primary cost-control measures of SB 5526, the capping of reimbursements to physicians and providers, was strongly opposed by the WSMA—<a href="https://wsma.org/Shared_Content/News/Membership_Memo/20190508/public_option_bill_passes_with_rate_setting_provision">learn more about our position</a>.) </p> <p> Don't miss this opportunity to learn about these plans—and how you can provide feedback to the state prior to their availability in 2021. </p> <p> Register for the webinar at the link below. For those unable to attend the live session, the webinar will be recorded and posted on the HCA or HBE's website. </p> <p> <strong>Cascade Care Webinar for Physicians and Providers</strong> <br /> Hosted by the HCA, HBE, and OIC <br /> 1–3 p.m. PST <br /> Monday, Dec. 16 <br /> Registration for this free session is required </p> <p><a href="https://register.gotowebinar.com/register/2216425629387780354">Register</a></p> </div>12/6/2019 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_december_2_2019_grateful_for_the_care_you_provideWeekly Rounds: December 2, 2019 - Grateful for the Care You ProvideLatest_NewsShared_Content/News/Weekly_Rounds/2019/weekly_rounds_december_2_2019_grateful_for_the_care_you_provide<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly-Rounds-Article-Graphic-645x425px.jpg" /></div> <h5>December 2, 2019</h5> <h2>Grateful for the Care You Provide </h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> My family, friends, and co-workers know that I'm more than a little bit obsessed with <a href="https://www.glassybaby.com/">glassybabys</a> (for the uninitiated, a glassybaby is a unique piece of hand-blown glass art crafted to support causes of hope and healing). </p> <p> I love the back story of how and why entrepreneur Lee Rhodes created them out of her own adversity to bring light and inspiration to people in need of it. I also love that part of the proceeds is donated to charity, and that each color has a story. </p> <p> Lately at the WSMA, when we've needed a special gift to say thank you—such as our gift for past president Donna Smith, MD—we choose a beautiful evergreen glassybaby called "gratitude." As a bonus, the color of "gratitude" perfectly matches the WSMA's new logo color. </p> <p> Gratitude is on my mind at the moment, and not just because I'm writing this column over the Thanksgiving weekend. Even as I write—from the warmth and joy of a family vacation in Maui—our trip is bittersweet because this may be the last opportunity my mom is able to travel. About two years ago, she received a diagnosis of nonalcoholic steatohepatitis, and now that her model end stage liver disease score has reached 15, we will soon determine what the next steps will be with the help of a transplant specialist. </p> <p> As we embark on this complex journey, I am grateful that we have access to the best and brightest physicians and health care professionals right in our community. And more than ever, I'm not only glad, but also incredibly proud of the work that the WSMA does to make that so. </p> <p> It's no surprise to us that one of the most pressing problems facing the physician community and our state is that there likely won't be enough physicians in the future to care for our burgeoning population here or elsewhere in the country. This is confirmed in a <a href="https://www.informz.net/WSMA/data/images/Documents/2019%20workforce%20report%20w-additions.d3.pdf" target="_blank">WSMA-commissioned workforce report</a> by John Gallagher that sheds light on state and local data to highlight the challenges ahead. </p> <p> The report quotes an analysis released by the Association of American Medical Colleges last April that the nation will experience a physician shortage of between 46,900 and 121,900 doctors by 2032 (the range reflects the difference between the 25th and 75th percentile of projections). The projected shortage of primary care physicians is as high as 55,200, and for physicians in surgical specialties as high as 23,400. </p> <p> Further, the report notes the expectation that Washington's population will grow by 1.8 million people by 2040. Most of this increase will be from people moving into the state, which will likely disproportionately impact the largest population areas in the state: Clark, King, Pierce, Snohomish, and Spokane counties. Also, the increased population will be more diverse, putting additional pressure on the need for linguistically and culturally appropriate health services. </p> <p> At the same time as the population is growing, it will also be getting older. By 2030, more than one in five state residents will be age 65 or older, compared with one in seven today. Twelve rural counties will have over 30 percent of their population older than 65, including Clallam, Jefferson, Stevens, and San Juan counties. An aging population presents more complex health conditions and needs, with a greater demand on health care and care coordination. </p> <p> What's to be done? At the WSMA, we are on the front lines advocating for access to care, debt forgiveness, increased funding for residencies, and more. This is what we do, all day, every day on behalf of you, our physician and physician assistant members. And that's a two-way street—we need you with us, and you belong with us. Help us ensure that Washington state is the best place to practice medicine and receive care by joining or renewing your membership today. </p> <p> I know that it's more challenging to be a physician today than in years gone by. But as I consider my mother's health burden, I couldn't be more grateful to those of you who've dedicated your lives and profession to caring for her and patients like her. </p> <p> I'm personally grateful to each of you. I wish you the inspiration and light of a flickering candle in a glassybaby called "gratitude," and hope that no matter the stress and the burdens you face, you'll keep caring for us all. </p> <p> Thank you. </p> </div>12/2/2019 12:00:00 AM1/1/0001 12:00:00 AM
2020_wsma_legislative_summit_registration_now_available2020 WSMA Legislative Summit Registration Now AvailableLatest_NewsShared_Content/News/Membership_Memo/20191127/2020_wsma_legislative_summit_registration_now_available<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/Events/2020-Leg-Summit-Article-645x425px.jpg" class="pull-right" /> </div> <h5> November 27, 2019 </h5> <h2> 2020 WSMA Legislative Summit Registration Now Available </h2> <p> Looking to engage in the political process more directly and help support WSMA's legislative advocacy? Register today to attend the <a href="https://wsma.org/WSMA/Events/Legislative_Summit/WSMA/Events/Legislative_Summit/Legislative_Summit.aspx?hkey=ec5e0510-cee2-4aa9-b549-905d63952454"> 2020 WSMA Legislative Summit</a> on Feb. 25 in Olympia and prepare to join your physician and physician assistant colleagues as we take our advocacy message directly to state lawmakers at the Capitol. </p> <p> At the Summit, you'll receive an overview of the health care issues at play in the 2020 legislative session and have an opportunity to meet with your legislative representatives. WSMA staff will brief you on our priority advocacy issues—those legislative or budget policies where your direct advocacy with elected officials can make the greatest difference—and share expert tips on how to meet with legislators. We'll provide a continental breakfast as well as lunch and will help to schedule personal meetings with your legislators in the afternoon. </p> <p> The event is free for WSMA members—one of the many benefits made possible by your dues dollars. <a href="https://wsma.org/WSMA/Events/Legislative_Summit/WSMA/Events/Legislative_Summit/Legislative_Summit.aspx?hkey=ec5e0510-cee2-4aa9-b549-905d63952454"> Register online today to reserve your spot</a>. If you have a white coat, wear it! The visual message of physicians, PAs, and medical students united in support of the profession and patients will be a powerful one. Help us turn advocacy into action while making the most of your membership with the WSMA— <a href="https://wsma.org/WSMA/Events/Legislative_Summit/WSMA/Events/Legislative_Summit/Legislative_Summit.aspx?hkey=ec5e0510-cee2-4aa9-b549-905d63952454"> join us in Olympia on Feb. 25.</a> </p> </div>11/27/2019 12:00:00 AM1/1/0001 12:00:00 AM
wsma_in_the_house_and_senate_representing_you_during_committee_assembly_daysWSMA in the House (and Senate) Representing You During Committee Assembly DaysLatest_NewsShared_Content/News/Membership_Memo/20191127/wsma_in_the_house_and_senate_representing_you_during_committee_assembly_days<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/capitol_bldg_645x425px.jpg" class="pull-right" /> </div> <h5> November 27, 2019 </h5> <h2> WSMA in the House (and Senate) Representing You During Committee Assembly Days </h2> <p> <em> </em> </p> <p> State lawmakers returned to the Capitol last week for committee assembly days. With the start of the 2020 legislative session just around the corner, committee assembly days give legislators an opportunity to connect with other legislators, staff, agencies, and stakeholders - including your WSMA staff - on issues relevant to the upcoming session. </p> <p> WSMA's legislative and government affairs team met with legislators throughout the week to review our 2020 priorities and hear what issues legislators are looking to work on in the health care arena. Legislators will be back in session (since it is an even-numbered year, it will be a "short" 60-day session) starting on Jan. 13. This work is made possible through your membership support, so please take a moment to renew your membership if you have not done so already. When physicians are united, the house of medicine is stronger— <a href="http://www.wsma.org/renew">renew today</a>. </p> </div>11/27/2019 12:00:00 AM1/1/0001 12:00:00 AM
your_feedback_sought_on_clinical_recommendations_for_reporting_risks_of_violenceYour Feedback Sought on Clinical Recommendations for Reporting Risks of ViolenceLatest_NewsShared_Content/News/Membership_Memo/20191127/your_feedback_sought_on_clinical_recommendations_for_reporting_risks_of_violence<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/wesley-tingey-9z9fxr_7Z-k-unsplash-gavel-645x425px.jpg" class="pull-right" /> </div> <h5> November 27, 2019 </h5> <h2> Your Feedback Sought on Clinical Recommendations for Reporting Risks of Violence </h2> <p> The Dr. Robert Bree Collaborative is seeking input on newly released draft clinical recommendations for outpatient mental health professionals caring for patients at elevated risk for violence. </p> <p> The draft recommendations are intended to address clinician uncertainty resulting from the 2016 Washington State Supreme Court decision in Volk v. DeMeerler, which held that a mental health professional who establishes a special relationship with a patient has a duty to protect any foreseeable victim from a patient's dangerous propensities. The decision was aggressively opposed by the WSMA and a large coalition of national and state partners due to its substantial expansion of clinician liability and the potential chilling effect on patient care. </p> <p> As noted in the draft, the Bree Collaborative is concerned about setting actionable recommendations in light of the standards set out in Volk, and suggests that even with these recommendations, legislative action is needed to address the questions raised by Volk (recommendations to the Legislature are included in the draft). </p> <p> Download and review the <a href="http://www.breecollaborative.org/wp-content/uploads/Bree-Risk-Violence-Others-DRAFT-19-1101.pdf" target="_blank"> Bree Collaborative's 'Risk of Violence to Others" recommendations</a>. To provide feedback, take the following <a href="http://www.surveymonkey.com/r/risk-violence-others"> brief online survey</a>. The deadline for feedback is 5 p.m. Friday, Dec. 27. </p> <p> Once final, Bree Collaborative recommendations provide guidance for clinicians seeking to engage patients in shared decision-making and help guide state purchasing for Medicaid and public employees. For more information, visit the <a href="http://www.breecollaborative.org/topic-areas/current-topics/risk-of-violence/"> Bree Collaborative website</a> or contact Ginny Weir at <a href="mailto:gweir@qualityhealth.org">gweir@qualityhealth.org</a> or 206.204.7377. </p> </div>11/27/2019 12:00:00 AM1/1/0001 12:00:00 AM
take_action_no_b_and_o_tax_increase_on_health_careTAKE ACTION: No B&O Tax Increase on Health Care!Latest_NewsShared_Content/News/Latest_News/2019/November/take_action_no_b_and_o_tax_increase_on_health_care<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Advocacy/NoToBO-Graphic-645x425px.jpg" class="pull-right" alt="No to B&O graphic" /></div> <h5>November 19, 2019</h5> <h2>TAKE ACTION: No B&O Tax Increase on Health Care!</h2> <p> State lawmakers are gathering this week in preparation for the 2020 legislative session, which begins in January. During session, lawmakers will have an opportunity to make adjustments to policy passed in 2019 - including a 20% business and occupation tax increase on health care that goes into effect on Jan. 1 and that will cost the physician community an estimated $50 million over the next two years. </p> <p> The WSMA is adamantly opposed to the B&O tax increase on health care, which will: </p> <ul> <li>Limit access to care for patients, particularly those covered by Medicaid.</li> <li>Disproportionately harm private practices and independent medical clinics—about a third or more of our state's physicians.</li> <li>Put a strain on many practices' ability to remain economically viable and competitive.</li> <li>Increase the burden on our state's emergency departments, increasing health care costs for everyone.</li> <li>Result in a loss of jobs, since independent practices run on tight margins.</li> <li>Impact the ability of practices to invest in innovations that improve patient care.</li> </ul> <p> <strong>Contact your state senator and representatives today and urge them to exempt health care from this unfair tax surcharge when they return to work in 2020.</strong> Let them know how the B&O tax increase will impact your practice and burden the health care system in Washington—hearing personal appeals and stories from constituents can make a difference, so please act today! </p> <p><a href="https://takeaction.wsma.org/no-bo-tax-increase-on-health-care/">Click here to take action</a>.</p> </div>11/19/2019 12:00:00 AM1/1/0001 12:00:00 AM
weekly_rounds_november_18_2019_democracy_in_action_at_the_wsma_house_of_delegatesWeekly Rounds: November 18, 2019 - Democracy in Action at the WSMA House of DelegatesLatest_NewsShared_Content/News/Weekly_Rounds/2019/weekly_rounds_november_18_2019_democracy_in_action_at_the_wsma_house_of_delegates<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="Weekly Rounds logo" class="pull-right" src="/images/Logos/Weekly-Rounds-Article-Graphic-645x425px.jpg" /></div> <h5>November 18, 2019</h5> <h2>Democracy in Action at the WSMA House of Delegates</h2> <p> Jennifer Hanscom, Executive Director/CEO </p> <p> Nearly three years ago, University of Washington President Ana Mari Cauce, while <a href="https://www.washington.edu/president/2017/01/16/pursuing-the-ideals-of-a-more-perfect-union/">reflecting on the ideals of a "more perfect union,"</a> said "The messiness of democracy is a feature, not a defect. The interplay of differing ideas, deeply held and passionately argued, is how we reach understanding. If we permanently retreat into like-minded bubbles of our own making, or if we treat democracy and discourse as zero sum games, then we do so at great cost to our society, and ultimately to ourselves." </p> <p> We're all reflecting these days on the messiness of democracy, as it plays out daily from the nation's Capitol to our own Hill in Olympia and in our own communities. Though it can be messy, I have seen it succeed in action. </p> <p> Most recently, your county and state specialty society delegates along with WSMA board members came forward on Oct. 12 and 13 at our 130th Annual Meeting of the House of Delegates to respectfully debate and deliberate policy for this organization. That work is member focused and member driven, as it not only represents member issues that impact the profession, but also responds to member needs in the professional environment and the care of their patients. </p> <p> We saw that quite clearly as your representatives in the House brought forward nearly 50 resolutions for consideration, many inspiring impassioned testimonies at the meeting. Once the yeas and nays were tallied, delegates had passed 45 new policies and nearly 30 directives to take action, reaffirmed four policies, modified one, and referred five items. We saw democracy at work—perhaps somewhat flawed at times—but always with good intentions and thoughtful interactions. </p> <p> In case you missed it, <a href="https://wsma.org/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx?hkey=fea49254-3815-4dc9-8710-53ff2e3a100f&WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927#video">watch this brief video</a> to see your peers in action. </p> <p> To recap all that happened as this energized House resolved to take progressive stands on public health policy and protect the health and well-being of physicians, here's a summary, including information on how to learn more. </p> <p> Policy adopted by delegates at the meeting typically falls into one of three categories: </p> <ol> <li>New policy (new policies are added to the <a href="https://wsma.org/WSMA/About_Us/Policies/Whats_Our_Policy/WSMA/About/Policies/Whats_Our_Policy/Policy_Index.aspx?hkey=f42b9a91-1f83-466f-ae3e-d58a7a6bd763">WSMA Policy Compendium</a> and help inform WSMA's advocacy in the Legislature, in the media, and in the industry at large).</li> <li>A reaffirmation of existing policy.</li> <li>A directive to take action.</li> </ol> <p> Policies "referred" by delegates go to WSMA leadership (the executive committee and board of trustees) for further consideration. </p> <p> This year, delegates directed your WSMA to: </p> <ul> <li>Advocate to amend state law to exempt all physicians from the B&O tax surcharge resulting from 2019 House Bill 2158.</li> <li>Explore options for tracking physician suicides and report back to the House in 2020.</li> <li>Support services to help assist physicians, residents, students, and PAs who are suffering symptoms of depression and burnout.</li> <li>Pursue, with stakeholder input, an aggressive strategy to reduce administrative burden.</li> <li>Support advocacy to eliminate the buprenorphine DEA waiver requirement.</li> <li>Publicize the interspecialty statement on "Firearm-Related Injury and Death in the United States: A Call to Action From the Nation's Leading Physician and Public Health Professional Organizations"</li> </ul> <p> Climate change was top of mind during the meeting, with delegates adopting policy to: </p> <ul> <li>Expand WSMA climate change policy (including directing the WSMA to divest from fossil fuels and encourage others in the health care industry to do the same).</li> <li>Support legislative efforts to create a low-carbon fuel standard for Washington state.</li> <li>Support the use of reusable isolation gowns.</li> </ul> <p> Public health, an ongoing concern of the House, was addressed by policy to: </p> <ul> <li>Endorse a ban on the sale of flavored e-cigarettes.</li> <li>Reduce firearm-related injury and death, including supporting research and legislative policy based on proven public health practices.</li> <li>Advocate for the removal of barriers to the immunization of "mature minors."</li> <li>Support improvements to the state's immunization information system.</li> <li>Support policy requiring pharmacies, when administering vaccines, to notify a patient's primary care provider when possible.</li> <li>Support the reform of health care access and delivery in the criminal justice system.</li> <li>Promote greater gender equity in medicine.</li> <li>Support physician education on critical race theory in medicine to help address disparate health outcomes of black Americans.</li> <li>Support investments to decrease racial inequities in cancer care.</li> <li>Support evidence-based sexual education; encourage legislation to expand sexual education to include contraception options, condom use demonstrations, LGBTQ+ sexual health, STI education, and discussions of consent.</li> <li>Support the rights of transgender and gender-nonconforming patients, including opposing legislative or other efforts to limit access to gender-affirming health services and encouraging health care facilities that provide direct patient care to adopt gender-affirming practices.</li> <li>Encourage better data-gathering on the victims of human trafficking; educate physicians on the issue and condemn the practice.</li> <li>Support efforts to encourage the wearing of helmets when riding e-scooters and e-bikes.</li> </ul> <p> Other policy adopted by the House call on the WSMA to: </p> <ul> <li>Work with partners to support legislation calling for an increase in primary care spending as a proportion of total health care spending.</li> <li>Support patients and referring clinicians knowing both the name and credentials of the clinicians to whom they are referred.</li> <li>Acknowledge the public health threat of medical misinformation.</li> <li>Oppose digital/online "coercion" of physicians and provide resources on managing one's online reputation.</li> <li>Oppose unpaid heath care data collection and data mining work for insurance company purposes, unless the provider chooses to provide it for free without coercion.</li> <li>Support establishing a statewide credentialing and onboarding process for medical and PA students from Washington state's medical schools.</li> </ul> <p> Referred policies (those issues needing additional study before further action) included: </p> <ul> <li>Policy advocating for the tracking of physicians sanctioned by the Washington Medical Commission and physician enrollees of the Washington Physician Health Program, with specific enumeration of physician suicides.</li> <li>Policy encouraging the Washington Medical Commission to use peer review when passing judgement on standards of care.</li> <li>Policy detailing standards for the prior authorization of prescription medication requests used by insurance companies regulated by the Office of the Insurance Commissioner.</li> <li>Policy directing the WSMA to take immediate action on gender inequities.</li> </ul> <p> For details on the above policies, and for a look at all policies and actions from the 2019 Annual Meeting, download the Official Actions of the 2019 WSMA House of Delegates, available from the <a href="https://wsma.org/WSMA/About_Us/Leadership/House_of_Delegates/WSMA/About/Leadership/House_of_Delegates/House_of_Delegates.aspx?hkey=e2c50002-384d-4ff7-9116-5ce7a51116e7">WSMA website</a>. The WSMA will update the status of these items on a monthly basis. </p> <p> This democratic work of policy setting is of the people, by the people, and for the people. The work needs you, and I hope you'll plan now to attend the 2020 WSMA Annual Meeting, Sept. 26-27 at the Historic Davenport, Autograph Collection in Spokane, and be part of it. To learn more about the Annual Meeting of the WSMA House of Delegates and its role shaping policy for the medical association, visit the <a href="https://wsma.org/WSMA/Events/Annual_Meeting/WSMA/Events/Annual_Meeting/Annual_Meeting.aspx?hkey=fea49254-3815-4dc9-8710-53ff2e3a100f">meeting webpage</a>. </p> <p> And don't forget: You can directly impact the democratic work of our state Legislature by attending our Legislative Summit on Feb. 25 at the state Capitol. This is medicine's moment to advocate for medicine's advocacy priorities. Be sure to save the date—free registration will be announced shortly. </p> </div>11/18/2019 12:00:00 AM1/1/0001 12:00:00 AM
cms_releases_medicare_2020_physician_fee_schedule_final_ruleCMS Releases Medicare 2020 Physician Fee Schedule Final RuleLatest_NewsShared_Content/News/Membership_Memo/20191113/cms_releases_medicare_2020_physician_fee_schedule_final_rule<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/invoice_645x425.jpg" class="pull-right" /> </div> <h5> November 13, 2019 </h5> <h2>CMS Releases Medicare 2020 Physician Fee Schedule Final Rule</h2> <p>The Centers for Medicare & Medicaid Services has finalized the 2020 Medicare physician fee schedule, updating payment policies for the federal insurance program as well as reporting and participation requirements for the Medicare Quality Payment Program Merit-based Incentive Payment System (MIPS) and alternative payment models (APM).</p> <p>Key provisions of the rule effective Jan. 1, 2020:</p> <ul> <li>A final 2020 conversion factor of $36.09, a slight increase above the 2019 conversion factor of $36.04.</li> <li>New telehealth service codes to describe a bundled episode of care for treatment of opioid use disorder.</li> <li>Updated requirements for physician supervision of PAs to give PAs greater flexibility.</li> <li>Modifications to medical record documentation policies to reduce duplication and burden.</li> <li>Increased payment for transitional care management services.</li> <li>Implementation of a new Medicare Part B benefit for opioid use disorder treatment services provided by opioid treatment programs.</li> </ul> <p>Key evaluation and management (E/M) provisions effective Jan. 1, 2021:</p> <ul> <li>Five levels of office/outpatient E/M coding for established patients; office/outpatient E/M visits for new patients are reduced to four levels by deletion of level 1; code definitions are revised.</li> <li>Revises the times and medical decision-making process for all CPT codes, and requires performance of history and exam only as medically appropriate; allows clinicians to choose the E/M visit level based on either medical decision-making or time.</li> </ul> <p>Key provisions for MIPS and APMs include:</p> <ul> <li>Increased performance threshold for the 2020 performance period.</li> <li>Increased the MIPS payment adjustment to +/- 9 percent.</li> <li>Maintains the (up to) 10 percent exceptional performance bonus and current MIPS performance category weights from the 2019 performance period.</li> <li>Increased reporting flexibility for APM entities and MIPS-eligible clinicians participating in APMs.</li> </ul> <p>For more information on the final rule:</p> <p><a href="https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other">CMS final rule</a></p> <p><a href="https://www.cms.gov/newsroom/press-releases/trump-administration-strengthens-medicare-reducing-provider-burden-and-valuing-time-spent-patients">CMS press release</a> (general)</p> <p><a href="https://www.cms.gov/newsroom/press-releases/trump-administration-takes-steps-expand-access-treatment-opioid-use-disorder">CMS press release</a> (opioid use disorder provisions)</p> <p><a href="https://www.cms.gov/newsroom/fact-sheets/finalized-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar">CMS Fee Schedule fact sheet</a></p> <p><a href="https://qpp-cm-prod-content.s3.amazonaws.com/uploads/737/2020%20QPP%20Final%20Rule%20Fact%20Sheet.pdf">CMS Quality Payment Program fact sheet</a></p> </div>11/13/2019 12:00:00 AM1/1/0001 12:00:00 AM
vitamin_e_acetate_linked_to_vaping_illnesses_doh_takes_actionVitamin E Acetate Linked to Vaping Illnesses; DOH Takes ActionLatest_NewsShared_Content/News/Membership_Memo/20191113/vitamin_e_acetate_linked_to_vaping_illnesses_doh_takes_action<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/vaping_store_645x425px.jpg" class="pull-right" /> </div> <h5> November 13, 2019 </h5> <h2>Vitamin E Acetate Linked to Vaping Illnesses; DOH Takes Action</h2> <p>Following a new study by the Centers for Disease Control and Prevention linking vitamin E acetate to the recent outbreak of vaping-related lung injuries, the Washington State Department of Health has asked Washington vapor product processors to stop adding vitamin E acetate to vapor products and to stop distributing products that contain it. The DOH has also asked all retailers to immediately stop selling vapor products that contain the ingredient.</p> <p>The CDC study found vitamin E acetate in 29 of 29 patients with vaping-associated lung injuries, though no single ingredient or compound has been determined to be the definitive cause of the outbreak.</p> <p>The DOH has identified 14 cases of vaping-associated lung injuries in Washington. In response to the outbreak, the DOH issued an emergency rule at the request of Gov. Jay Inslee temporarily banning the sale of flavored vapor products and imposing <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20191023/new_rules_require_physicians_to_report_lung_injuries_within_three_days">new reporting rules</a> on physicians and other clinicians. The WSMA House of Delegates voted unanimously in October to <a href="https://wsma.org/Shared_Content/News/Latest_News/2019/October/king_county_medical_society_and_washington_state_medical_association_endorse_ban_on_flavored_e_cigar.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">support a permanent ban on the sale of flavored e-cigarettes in the state</a>, an issue we expect to be addressed in the upcoming state legislative session.</p> <p>At the federal level, President Donald Trump has promised a crackdown on vaping, and the Food and Drug Administration is expected to issue details this week on a ban to restrict sales of flavored e-cigarettes and raise the age of sale for some tobacco products from 18 to 21. At the time of this writing, details have not yet been released.</p> </div>11/13/2019 12:00:00 AM1/1/0001 12:00:00 AM
you_belong_with_us_its_time_to_pay_your_membership_duesYou Belong With Us! It's Time to Pay Your Membership DuesLatest_NewsShared_Content/News/Membership_Memo/20191113/you_belong_with_us_its_time_to_pay_your_membership_dues<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/LS_2018.01-196-645x425px.jpg" class="pull-right" /> </div> <h5> November 13, 2019 </h5> <h2>You Belong With Us! It's Time to Pay Your Membership Dues</h2> <p>WSMA members will receive their 2020 membership renewal notice in the mail this month. Along with your notice, you'll find our <a href="https://wsma.org/WSMA/Membership/Why_Join_the_WSMA/Our_Impact/WSMA/Membership/Why_Join_the_WSMA_/Our_Impact.aspx?hkey=4cbb82b9-b1fe-4983-8e98-9208c0f6fe95">2019 Impact Report</a>, showing how the WSMA worked to protect you, your profession, and your patients this year. With your membership, we can do even more next year - renew today!</p> <p>Your dues dollars facilitate the work the WSMA does on your behalf to shape the future of medicine and advance quality care in our state. In return, the WSMA ensures your voice is heard, advocates for the profession, influences the public and civic leaders, seeks meaningful change at system and regulatory levels, and provides you with tools to cope and thrive within the ever-changing health care environment.</p> <p>Your membership fuels this work. Although the costs associated with advocacy work rise each year, your membership dues have remained stable for 10 years. Please renew your membership <a href="http://www.wsma.org/renew">online</a> or by mailing in your dues statement on receipt. If you have CME and/or employee benefit funds, we encourage you to use those resources to cover your membership dues.</p> <p>Members who are covered by Physicians Insurance A Mutual Company need to maintain their WSMA membership in order to retain the $300 annual discount on their liability insurance premium. For personal assistance, email <a href="mailto:membership@wsma.org">membership@wsma.org</a>. To pay dues by phone call 206.441.9762.</p> <p>We are stronger and better together. Thank you!</p> </div>11/13/2019 12:00:00 AM1/1/0001 12:00:00 AM
call_for_nominations_2020_ama_mss_meeting_scholarshipsCall for Nominations: 2020 AMA-MSS Meeting ScholarshipsLatest_NewsShared_Content/News/Latest_News/2019/November/call_for_nominations_2020_ama_mss_meeting_scholarships<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="" src="/images/News/AM_2018.10.241-645x425px.jpg" class="pull-right" /></div> <h5>November 11, 2019</h5> <h2>Call for Nominations: 2020 AMA-MSS Meeting Scholarships</h2> <p> The WSMA is accepting nominations for three medical student scholarships to attend the 2020 AMA Medical Student Section's annual (June 4-6 in Chicago) and interim (Nov. 12-14 in San Diego) meetings. </p> <p> The scholarships provide funding to support three WSMA medical student members, one each from the University of Washington School of Medicine, the Elson S. Floyd College of Medicine at Washington State University, and the Pacific Northwest University of Health Sciences, to attend both meetings. The funding allocation is up to $1,000 per student, per meeting. </p> <p> To qualify, nominees must: </p> <ul> <li>Be an active WSMA and AMA member medical student in good standing at the time of nomination</li> <li>Have the support of the WSMA's Medical Student Section governing council. </li> <li>Demonstrate a strong interest and involvement in health care policy.</li> <li>Possess excellent communication skills and willingness to advocate for patients and the profession.</li> <li>Be committed and able to attend both meetings as a representative of the WSMA.</li> <li>Be willing to provide a written report to the WSMA's executive committee and verbal report to WSMA Early Career Sections' governing councils about their experience at the AMA meetings.</li> </ul> <p> Nominate yourself or a colleague using the online survey tool at the link below. You'll be prompted for a personal statement of interest and your CV; letters of recommendation are welcome but not required. The deadline for nominations is Wednesday, Nov. 27. </p> <p> The WSMA Medical Student Section governing council will review all submissions and submit a slate of nominees to the WSMA executive committee for consideration and final decision at its February 2020 meeting. </p> <p><a href="https://www.surveymonkey.com/r/X63MV9C">Click here to apply</a></p> </div>11/11/2019 12:00:00 AM1/1/0001 12:00:00 AM
winter_wsma_leadership_courses_now_enrollingWinter WSMA Leadership Courses Now EnrollingLatest_NewsShared_Content/News/Latest_News/2019/November/winter_wsma_leadership_courses_now_enrolling<div class="col-md-12"> <div class="col-md-5 pull-right"><img src="/images/Events/PLC-Swedish-Dec.%202019-645x425px.jpg" class="pull-right" alt="Physician Leadership Course" /></div> <h5>November 6, 2019</h5> <h2>Winter WSMA Leadership Courses Now Enrolling</h2> <p> Applications are now being accepted for two of our core leadership trainings scheduled for this winter: The popular WSMA Physician Leadership Course, our hybrid online/in-person education designed for busy physicians and physician assistants who want to learn more about leadership, and the WSMA Dyad Leadership Course, a three-day workshop for physicians and their administrative partners. </p> <h3>Physician Leadership Course</h3> <p> The <a href="[@]WSMA/Resources/Physician_Leadership/Physician_Leadership_Course/Physician_Leadership_Course.aspx">WSMA Physician Leadership Course</a> is a 40+ hour hybrid-distance leadership skills-development course for physicians and physician assistants who want to know more about health care leadership. Designed with a physician's busy schedule in mind, only three in-person classes are required; the remainder of the course is conducted online. </p> <p> The winter 2020 Physician Leadership Course will be held Jan. 31-April 17. The in-person classes will be held Friday and Saturday, Jan. 31 and Feb. 1 in Seattle. Course participants will then have eight weeks of online instruction and interaction, finishing with a third in-person session on Saturday, April 17. </p> <p> This activity has been approved for <em>AMA PRA Category 1 Creditâ„¢</em>. Deadline for enrollment is Nov. 29. </p> <h3>Dyad Leadership Course</h3> <p> The <a href="[@]WSMA/Resources/Physician_Leadership/Dyad_Leadership_Course/Dyad_Leadership_Course.aspx">WSMA Dyad Leadership Course</a> is our three-day, in-person educational workshop for physicians and their administrative dyad partners who wish to improve team function and achieve greater operational success within their clinical system. The course is adapted to fit the specific clinical culture of participating teams. </p> <p> The winter 2020 course will be held Feb. 14-March 13. The in-person classes will be held Friday and Saturday Feb. 14 and 15 in Seattle. Course participants will then have four weeks of online instruction and interaction, finishing with a third in-person session on Friday, March 13. </p> <p> To enroll in the WSMA Dyad Leadership Course, physicians must first complete the WSMA Physician Leadership Course. This activity has been approved for <em>AMA PRA Category 1 Creditâ„¢</em>. Deadline for enrollment is Dec. 13. </p> </div>11/6/2019 12:00:00 AM1/1/0001 12:00:00 AM
cognitive_dissonanceCognitive DissonanceLatest_NewsShared_Content/News/Latest_News/2019/November/cognitive_dissonance<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Nov-Dec-2019-Reports-645x425px.jpg" class="pull-right" alt="WSMA Reports November/December 2019" /></div> <h5>November 5, 2019</h5> <h2>Cognitive Dissonance</h2> <p> </p> <p> By Pat Curry </p> <p> For 10 years, Carl Berliner, MD, has been a solo family practitioner. He runs his practice out of a renovated house in Mt. Vernon, a community of 30,000 known for its annual tulip festival. His patients range in age from two days old to their late 90s. It brings him great joy, he says, to have delivered a third of them, many of whom call him "Dr. B." </p> <p> Being a solo practitioner gives him what he calls "agency," the ability to control his day and his practice. A lot of physicians traded agency for better pay "and now they wish they hadn't," he says. </p> <p> "It's just enormous, that ability to make extra time in your schedule and treat patients the way you think you should. … I always have this joke that I'm the last happy doctor in Washington. I live frugally enough that I weather these insanities. 'Cognitive dissonance' is the term I use." </p> <p> The dissonance comes from trying to make enough money to keep the doors open. </p> <p> "I don't like to talk about finances, but we are a business and have to pay bills and pay staff," he says. "We say we want healthy families, then make that almost impossible to happen. … Keeping up with the rules and fighting over every $14 charge is very discouraging. In the execution, you feel like you've been run over by a tractor." </p> <p> And then there are the day-in and day-out challenges in getting approval from insurers to perform even the most standard levels of medical care. </p> <p> "Prior authorization is an enormous time suck," he says, "and it's a reason why so many [physicians] are demoralized. At the end of the day, I don't leave with a smile because for six of the drugs I prescribed, I needed to click another radio button. I had a pregnant woman I prescribed prenatal vitamins for and the insurance company required prior authorization. On the form, I wrote, 'You are the worst insurance company ever.' " </p> <h3>Difficult decisions with few options</h3> <p> Without relief, some physicians have found that they have no choice but to shut down and go on someone else's payroll. In August, Cascade Family Medical Clinic in Centralia closed after more than 40 years. </p> <p> Eric DeMun, MD, and Christopher Yarter, MD, posted on the clinic's website that the practice was "one of a shrinking group of small, independent primary care clinics that is suffering from increasing administrative burdens, rising costs of health care delivery, and a reimbursement system that has not kept pace with these costs. We have been unable to recruit physicians to partner with us in the face of these changes and have been unsuccessful in finding larger companies willing to buy the practice and keep it open." </p> <p> Many physicians in small practices in Washington state face the same kind of gut-wrenching decisions. Eric Frankenfeld, MD, FACE, FACP, is an endocrinologist in solo practice in Bellingham, a physician-shortage area. This summer, he sweated out a lease renewal; the rent increase would determine if he stayed in business or retired. He negotiated a two-year lease instead of five years, enough for him to decide to keep at it a bit longer. </p> <p> He's been aware for 25 years that it was "no way to make money," he says. </p> <p> "I thought it was me, that I'm not enough of a hustler, not in a busy-enough practice, whatever," he says. "Then I talked to other colleagues over the years and found out they were doing worse than I was. You need a gimmick if you're going to make money in medicine. The gimmick is you perform a nice expensive procedure like endoscopy. Internists in general, and nonprocedural subspecialists without a gimmick, need to get themselves employed." </p> <p> At 66, Dr. Frankenfeld says that as long as he can break even, fund his pension and his staff's pensions, he will continue to practice. He is ready to retire, though, from his second career as a hospitalist, which he has done half-time for 10 years. </p> <h3>The burden of fees and taxes</h3> <p> Working both as a solo practitioner and as a health system employee has been an eye-opener, he says, especially when it comes to state fees and taxes. With the state eyeing drastically increasing physician licensing fees, Dr. Frankenfeld wondered if it might be time for him to think about closing the doors on his private practice. </p> <p> "This may be what does it for me," he says. "My reimbursements certainly haven't doubled in the last few years. How does a license become that valuable to me?" </p> <p> He says the "biggest burr in my saddle" is the business and occupation, or B&O, tax. </p> <p> "I think that is the most unfriendly thing to small businesses," he says. </p> <p> The B&O tax, which is applied on a business' gross revenues, has been a long-standing point of contention for independent physicians, says Sean Graham, WSMA's director of government affairs. A bill passed last year added a 20 percent surcharge on certain industries with a significant number of highly educated workers, with the additional revenue going to higher education. </p> <p> The fiscal impact of the tax increase on the physician community over the next two years is estimated at about $50 million, Graham says. Hospital systems were exempted from the tax surcharge as they are classified separately for the purposes of B&O. </p> <p> WSMA strenuously opposes the B&O tax on all segments of health care and "vehemently" fought the surcharge, Graham says. Repealing the tax on physicians will be the "A-1 priority of WSMA for the 2020 legislative session," he says. </p> <p> "It's simply a wrongheaded tax increase on a couple of levels, among them that it further increases the cost of health care," he says. "And it puts independent practices at a competitive disadvantage, jeopardizing access to care for patients in many communities." </p> <p> The WSMA will be rolling out a broad advocacy campaign on repealing or ameliorating the B&O tax in the next legislative session and will be asking our physician members for their help. </p> <p> "We'll be working to raise awareness of the impact of the surcharge on patients and physicians, as well as to get physicians directly connected to their legislators," he said. </p> <p> Mark T. Anderson, MD, a founding member of the independent Mill Creek Family Practice in Mill Creek, is one of the physicians who has volunteered to share his concerns with elected officials. His practice is "still doing OK," but faced with lower reimbursements, burdensome documentation and preauthorization requirements, and the B&O tax increase, it's getting harder and harder to compete against hospital-based primary care clinics. </p> <p> "We are one of the very few independent family practice clinics left," Dr. Anderson says. "We would like to continue to practice independently." </p> <p> <em>Pat Curry is WSMA Reports' senior editor.</em> </p> <p> <em>This article was featured in the November/December 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>11/5/2019 12:00:00 AM1/1/0001 12:00:00 AM
do_no_harmDo No HarmLatest_NewsShared_Content/News/Latest_News/2019/November/do_no_harm<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Nov-Dec-2019-Reports-645x425px.jpg" class="pull-right" alt="WSMA Reports November/December 2019" /></div> <h5>November 5, 2019</h5> <h2>Do No Harm</h2> <p> </p> <p> By Daniel Low, MD </p> <p> In the midst of ever-increasing health care costs, we are obligated to think about and practice value-based care. What sadly is too often lost in this conversation, however, is the definition of "value." What are our values? </p> <p> As physicians, we have all proclaimed via the Hippocratic Oath that we will "first, do no harm." Yet, current data seems to suggest that this theoretically unifying value reflects more of a distant ideal than a guiding principle. </p> <p> By now, it is well known that black patients are less likely to be treated for pain in emergency departments, women are less likely to be treated for heart disease, immigrants are less likely to receive care, and those who are economically disadvantaged are more likely to suffer early morbidity and mortality. </p> <p> While acknowledged as unfortunate, these disparities are generally viewed as inevitable, and thus, acceptable. This convention of normalcy must stop. Patients deserve health care providers who advocate for their best interests. </p> <p> What might this look like? It means taking responsibility as physicians to not just organize to benefit ourselves financially—which has been the historic norm (e.g., the American Medical Association's partnership with the Sunbeam Corporation, the American Heart Association's exploitation of its heart logo for profit over health, the American Academy of Family Physicians' collaboration with Coca-Cola, etc.)—but rather to organize for our patients. Specifically, this would mean formally supporting campaigns targeting health inequities. </p> <p> Fortunately, we don't have to look far for obvious opportunities. Study after study over the last 30 years has shown that income inequality drives poor health outcomes and may be one of the central causes of poor health in the United States. In Washington state, this is perpetuated by regressive tax systems—Washington ranks last in the country in disproportionately burdening low-income earnershelping guarantee the poor stay poor and continue enduring harm that we, as physicians, claim we will not do. We can instead follow the lead of groups like Washington Physicians for Social Responsibility, which advocates for cleaning up our tax code and enacting a capital gains tax. </p> <p> As we discuss value-based care, we too often excuse rising health care costs as unrelated to our individual responsibility because physician salaries are not the cause for increasing costs. But such claims, while true, are red herrings. They distract us from the reality that increasing economic inequality is arguably the central force driving poor health outcomes in our communities, and economic inequality is something we can address. </p> <p> Continuing business as usual—or trying to incrementally alter payment models in value-based care without addressing the structural violence enacted by our tax system—is a formula to ensure we continue harming disenfranchised individuals and communities. Ultimately, if our value is to do no harm, we must attack a system that guarantees unequal care to those who are different. We must organize, and we must support the redistribution of resources, putting our own pocketbooks on the table. </p> <p> <em>This opinion piece was submitted by Daniel Low, MD, a family medicine resident physician at Swedish Cherry Hill in Seattle and an alternate delegate from King County Medical Society to the WSMA House of Delegates.</em> </p> <p> <em>This article was featured in the November/December 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>11/5/2019 12:00:00 AM1/1/0001 12:00:00 AM
preparing_for_value_based_carePreparing for Value-Based CareLatest_NewsShared_Content/News/Latest_News/2019/November/preparing_for_value_based_care<div class="col-md-12"> <div class="col-md-5 pull-right" style="text-align: center;"><img src="/images/News/Nov-Dec-2019-Reports-645x425px.jpg" class="pull-right" alt="WSMA Reports November/December 2019" /></div> <h5>November 5, 2019</h5> <h2>Preparing for Value-Based Care</h2> <p> </p> <p> By Rita Colorito </p> <p> When a homeless cancer patient came to Northwest Cancer Clinic in Kennewick for radiotherapy, Sheila Rege, MD, a radiation oncologist and co-founder of the clinic, knew treatment would be challenging. </p> <p> The patient's situation made maintaining hygiene difficult, and Dr. Rege worried it could cause her to develop skin infections during radiation. Plus, she had other chronic medical issues, including uncontrolled diabetes that once caused dangerously elevated blood pressure. Dr. Rege and her staff put systems in place to achieve the best outcome possible for the patient. They let her shower at the clinic and delivered food and warm clothing to the car she called home. They called her daily to remind her to take her medications. </p> <p> When the patient needed more help, Dr. Rege's staff negotiated with a hotel to house her for the remainder of treatment. "There was a lot more time and care that we had to do for her," Dr. Rege says. </p> <p> The patient is now doing well, a function of value-based care being applied across the clinic's patient population, Dr. Rege says. </p> <p> "We really try and not highlight who is on a risk-based contract. We focus on keeping people out of the emergency room," she says. "So, we're going to accept a risk-based contract, but we're really going to bring everyone else to that level." </p> <p> As public and private payers undergo a major transition to value-based care (VBC) models, Dr. Rege hopes physicians can continue to care for this type of vulnerable patient, and those with treatment challenges, without the patient or the practice getting short shrift. </p> <p> "All of us want to do better for our patients; everyone is trying to reduce what I call the hassle factor in medicine," Dr. Rege says. "But as we're going through these dramatic changes in how we pay for care, we have to make sure the vulnerable people, the people having a harder time either accessing care or tolerating treatment, don't suffer. We also have to make sure incentives are aligned to allow physicians to care for them." </p> <h3>A dramatic shift in focus</h3> <p> It seems like only a few years ago that VBC entered the lexicon of health care buzzwords. This reimbursement model rewards physicians for meeting agreed-upon quality metrics. It can also penalize them when those metrics aren't met. </p> <p> If you've been sitting on the fence about VBC, you may no longer have the option of waiting, says Micah Thorp, DO, a nephrologist and clinical researcher with Northwest Permanente. </p> <p> "Value-based is going to be the primary form of payment in the not-too-distant future. It's coming pretty fast and you've got to get ready for it," says Dr. Thorp, who also serves as vice president of business strategy for Kaiser Permanente. </p> <p> At the state level, the Health Care Authority's Healthier Washington initiative plans to drive 90 percent of state-financed health care—more than 2 million people on Medicaid and those who receive public employee, state school employee, and retiree benefits—to value-based payment by 2021. At the federal level, the Centers for Medicare & Medicaid Services has rolled out eight value-based care models since 2018, with the triple aim of better care for individuals, better care for populations, and lower cost. </p> <p> The aim of VBC models is to allow physicians to concentrate on taking care of patients. "For value-based care to work, it's important for providers to free up their PCPs. They can really drive savings in other areas," says Mark Mantei, CEO of Vancouver Clinic. "This isn't a model built on seeing 30 patients a day. This is a model that takes up more time, but we're rewarded for that because your patients don't end up in the ER or hospital." </p> <p> Vancouver Clinic began transitioning to VBC for its Medicare population six years ago, after realizing traditional Medicare was no longer sustainable. Earlier this year, it partnered with Humana to open a dedicated primary care clinic in Southwest Washington designed to serve Medicare Advantage beneficiaries and those on Dual Eligible Special Needs Plan (those who qualify for both Medicare and Medicaid); it also accepts commercial insurance. </p> <p> The clinic's integrated care team includes doctors, nurses, nutritionists, and health coaches. Representatives from both Humana and the Agency on Aging and Disabilities of Southwest Washington hold office hours several days a week to help patients navigate their benefits and manage outside factors that affect health outcomes, such as housing, transportation, mental health, and home care. </p> <p> Despite a 40 percent higher-than-average risk adjustment factor for the clinic's Medicare population, it's had some amazing successes already that speak to the power of value-based care, Mantei says. "We saw patients that were in the hospital 16 times last year before that clinic was implemented. And since then, they've only been in the hospital once." </p> <h3>Despite challenges, smaller practices and specialties can benefit</h3> <p>Dr. Thorp oversees contracting with external providers in areas where Kaiser Permanente lacks a local specialty presence. These physician groups often struggle with transitioning from an efficiency mindset to a utilization mindset, the latter of which is central to value-based care, he says. </p> <p> "Fee-for-service drives great efficiency. It also does terrible things to utilization," he says. "The value-based model basically says, 'Let's treat people with what they actually need' rather than just treating them with a lot of stuff they don't need, but doing it very efficiently." </p> <p> Having enough high-quality baseline data is another issue physicians struggle with in negotiating and implementing VBC contracts, Dr. Thorp says. "You need to have a good idea of where you are starting from to gauge progress," he says, adding that electronic medical records can provide a wealth of information to track clinical quality, population data, and other metrics. Robust patient data, he says, also safeguards against a common criticism of VBC—that physicians will take a lump-sum payment and withhold services to meet metrics. </p> <p> To position her practice to best take advantage of VBC models, Dr. Rege entered into a joint venture and management contract with 21st Century Oncology, a large national physician-owned oncology group. </p> <p> "Value-based and risk-based only work if you can provide data that shows you are improving outcomes and being more efficient," which is something Dr. Rege says her clinic lacked. It made sense to partner with 21st Century Oncology, she says, because they have experience managing risk-based contracts and could provide the necessary investments to train her team and conduct financial reporting. </p> <p> To better serve patients, it's important to be able to access a patient's health records in a HIPAA-compliant manner in and outside the office, says Dr. Rege. Northwest Cancer Clinic also benefited from 21st Century's more advanced medical records capabilities. "We were on the same system, but they were able to beef it up," she says. "[And] they already had an existing contract with an electronic medical record provider to generate all those reports that would be needed by the insurance companies." </p> <p> Risk adjustment is another major concern when transitioning to a capitated payment system. It's even more so with cancer treatment, says Dr. Rege. </p> <p> "We don't know what causes someone to do great with cancer treatment and what causes some people to end up in the ICU," she says. "In a value-based system, we have to figure out a way that sicker patients aren't left out. And so far, no insurance company knows who's going to do okay on treatment and who is going to have trouble." </p> <p> Northwest Cancer Clinic's VBC contracting has flexibility to account for that uncertainty, Dr. Rege says. The corporate office of 21st Century Oncology acts as a "shadow team," she says, that helps her staff assist patients who are struggling with treatment by acting as an intermediary with insurers. </p> <p> She warns physicians and practices against entering into VBC systems with rigid metrics. "If a patient is an outlier, it's important to have the flexibility with insurance providers to discuss next steps," she says. An open dialogue with insurers allows Dr. Rege to manage costs while providing patients the best care possible. </p> <p> As Medicare is driving the larger health care space toward VBC, Dr. Rege expects it to drive oncology reimbursement as well. For now, Northwest Cancer Clinic's VBC contracts are in the commercial insurance space. Medicare oncology care model (OCM) pilot projects are only a few years old. "While quality and cost performance results across OCM practices continue to improve, only 33 percent of practices have earned a performance-based payment so far," Dr. Rege says. As these models evolve, she remains hopeful Medicare and Medicaid will keep the health of both the patient and the physician practice in mind. </p> <p> Despite some of the challenges faced by smaller clinics, Dr. Thorp says he's seen some of the biggest benefits of VBC among smaller physician practices. "You're getting a guaranteed per-patient, per-month money. It can stabilize cash flow," he says. </p> <p> One of the biggest rewards for Northwest Cancer Clinic's VBC contracting has been eliminating prior authorization for evidence-based treatment, a huge time saver for both physicians and patients, Dr. Rege says. The clinic receives capitated payments specific to each cancer type, with care decisions following established clinical guidelines. </p> <p> "You have to reduce the cost for the practice in some way," Dr. Rege says. </p> <p> "If a bunch of your staff is doing prior authorizations and documentation, that's time the staff could've spent on the patient. So when a patient comes in, we can say, 'This is what you need.' If they say, 'Can we start now? ', we can say, 'Yes, we can.' " </p> <p> <em>Rita Colorito is a freelance journalist who specializes in writing about health care.</em></p> <p> <em>This article was featured in the November/December 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may <a href="https://wsma.org/WSMA/News_Publications/Publications/WSMA/News_Publications/Publications/Publications.aspx?hkey=8f14076c-10b8-48ab-9595-8c256836e393">purchase a subscription</a>.</em> </p> </div>11/5/2019 12:00:00 AM1/1/0001 12:00:00 AM
Register_for_OIC_Webinar_on_Balance_Billing_Protection_ActRegister for OIC Webinar on Balance Billing Protection ActLatest_NewsShared_Content/News/Latest_News/2019/October/Register_for_OIC_Webinar_on_Balance_Billing_Protection_Act<div class="col-md-12"> <div class="col-md-5 pull-right"><img alt="balance billing" src="/images/Concepts/balance_billing_invoice_645x425.jpg" class="pull-right" /></div> <h5>October 30, 2019</h5> <h2>Register for OIC Webinar on Balance Billing Protection Act</h2> <p> On Wednesday, Nov. 13, from noon to 1:30 p.m., the Office of the Insurance Commissioner will host a free webinar designed for physicians, providers, and practice staff on implementation of House Bill 1065, the Balance Billing Protection Act (BBPA). The WSMA provided guidance to OIC staff on the content of the webinar, which will cover provisions of the BBPA that address: </p> <ul> <li> Out-of-network provider payment and dispute resolution process. </li> <li>Transparency. </li> <li>Enforcement. </li> <li>Self-funded group health plan participation. </li> </ul> <p> The Balance Billing Protection Act takes effect Jan. 1, 2020—make sure you and your practice are prepared by attending this session. </p> <p> Registration for this free session is required. When registering for this webinar, you will need to enter the following information:<br /> <strong>Meeting number</strong>: 809469205 (enter in "meeting information" field)<br /> <strong>Meeting password</strong>: 4q3cQgAx</p> <p><a href="https://watech.webex.com/mw3300/mywebex/default.do?siteurl=watech" class="TextButton">Register</a></p> </div>10/31/2019 11:24:53 AM1/1/0001 12:00:00 AM
 

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